Healthcare Provider Details

I. General information

NPI: 1518950617
Provider Name (Legal Business Name): JASMINE GRACE JEFFERS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 MEDICAL PARK DR SUITE 300
AUSTELL GA
30106-1109
US

IV. Provider business mailing address

3825 MEDICAL PARK DR SUITE300
AUSTELL GA
30106-1109
US

V. Phone/Fax

Practice location:
  • Phone: 770-941-4810
  • Fax: 770-948-9149
Mailing address:
  • Phone: 770-941-4810
  • Fax: 770-948-9149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number39136
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: